Zou Zhi-Ye, Wang Bin, Peng Wen-Jun, Zhou Zhi-Peng, Huang Jia-Jia, Yang Zhen-Jia, Zhang Jing-Jing, Luan Ying-Yi, Cheng Biao, Wu Ming
Department of Critical Care Medicine and Hospital Infection Prevention and Control, Shenzhen Second People's Hospital & First Affiliated Hospital of Shenzhen University, Shenzhen, China.
Department of Ultrasound, Longgang Central Hospital of Shenzhen, Shenzhen, China.
Front Cardiovasc Med. 2022 May 27;9:879812. doi: 10.3389/fcvm.2022.879812. eCollection 2022.
In updated international guidelines, combined albumin resuscitation is recommended for septic shock patients who receive large volumes of crystalloids, but minimal data exist on albumin use and the optimal timing in those with cardiogenic shock (CS). The objective of this study was to evaluate the relationship between resuscitation with a combination of albumin within 24 h and 30-day mortality in CS patients.
We screened patients with CS from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Multivariable Cox proportional hazards models and propensity score matching (PSM) were employed to explore associations between combined albumin resuscitation within 24 h and 30-day mortality in CS. Models adjusted for CS considered potential confounders. -value analysis suggested for unmeasured confounding.
We categorized 1,332 and 254 patients into crystalloid-only and early albumin combination groups, respectively. Patients who received the albumin combination had decreased 30-day and 60-day mortality (21.7 vs. 32.4% and 25.2 vs. 34.2%, respectively, < 0.001), and the results were robust after PSM (21.3 vs. 44.7% and 24.9 vs. 47.0%, respectively, < 0.001) and following -value. Stratified analysis showed that only ≥ 60 years old patients benefited from administration early albumin. In the early albumin combination group, the hazard ratios (HRs) of different adjusted covariates remained significant (HRs of 0.45-0.64, < 0.05). Subgroup analysis showed that resuscitation with combination albumin was significantly associated with reduced 30-day mortality in patients with maximum sequential organ failure assessment score≥10, with acute myocardial infarction, without an Impella or intra-aortic balloon pump, and with or without furosemide and mechanical ventilation (HRs of 0.49, 0.58, 0.65, 0.40, 0.65 and 0.48, respectively; < 0.001).
This study found, compared with those given crystalloid-only, resuscitation with combination albumin within 24 h is associated with lower 30-day mortality of CS patients aged≥60. The results should be conducted to further assess in randomized controlled trials.
在更新的国际指南中，建议对接受大量晶体液治疗的感染性休克患者采用白蛋白联合复苏，但关于心源性休克（CS）患者白蛋白的使用及最佳时机的数据极少。本研究的目的是评估CS患者在24小时内进行白蛋白联合复苏与30天死亡率之间的关系。
我们从重症监护医学信息数据库IV（MIMIC-IV）中筛选出CS患者。采用多变量Cox比例风险模型和倾向评分匹配（PSM）方法，探讨CS患者在24小时内进行白蛋白联合复苏与30天死亡率之间的关联。针对CS的模型考虑了潜在的混杂因素。通过 -值分析评估未测量的混杂因素。
我们分别将1332例和254例患者分为单纯晶体液组和早期白蛋白联合组。接受白蛋白联合治疗的患者30天和60天死亡率降低（分别为21.7%对32.4%和25.2%对34.2%，<0.001），PSM后结果依然稳健（分别为21.3%对44.7%和24.9%对47.0%，<0.001）以及在 -值分析后也是如此。分层分析显示，只有年龄≥60岁的患者从早期白蛋白给药中获益。在早期白蛋白联合组中，不同调整协变量的风险比（HR）仍然显著（HR为0.45 - 至0.64，<0.05）。亚组分析显示，对于序贯器官衰竭评估最高评分≥10分、患有急性心肌梗死、未使用Impella或主动脉内球囊泵以及使用或未使用速尿和机械通气的患者，白蛋白联合复苏与30天死亡率降低显著相关（HR分别为0.49、0.58、0.65、0.40、0.65和0.48；<0.001）。
本研究发现，与单纯给予晶体液的患者相比，60岁及以上的CS患者在24小时内进行白蛋白联合复苏与较低的30天死亡率相关。该结果应在随机对照试验中进一步评估。
